Injecting Fear

Low rates of dog vaccination have hindered efforts to eliminate rabies despite massive consumption of human-use vaccines – and irrational fears about the disease are compounding the problem

By
NewsChina
Updated May.1

Rabies fears revived in China after Changchun Changsheng Life Sciences, a leading vaccine supplier in the capital of Jilin Province was discovered to have faked production data and used expired raw materials. In response, authorities distributed free remedial vaccinations to those affected. But the generally accepted fallacy that the rabies virus can lie dormant in the body for decades persists – and continues to frustrate public health efforts.

Many Chinese people believe that if someone bitten by a dog is not vaccinated within 24 hours, the virus can lurk in them for up to 20 years. Despite efforts by doctors and experts to educate the public that rabies generally develops within three months – and that people can be confident they are virus-free if the animal remains symptomless for 10 days after the bite, a World Health Organization (WHO) guideline, the virus’ near-100 percent mortality rate has helped to stoke fears.

Rabies remains a serious concern in China. Official data shows the nation reported 516 cases in humans in 2017 with 502 deaths, making it the infectious disease with the fourth-highest death toll in China after AIDS, tuberculosis and the combined strains of viral hepatitis. Yan Jiaxin, a former rabies examiner and researcher for the State-owned Wuhan Institute of Biological Products, said China sees an average of 15 million people vaccinated against rabies each year. But writing for a recent edition of NewsChina’s Chinese edition, he said the nation had gone about tackling the issue in the wrong way – the focus should be on the source of the infections. “More than 60 percent of Chinese dogs are not vaccinated against rabies, while several dozen times the money has been spent vaccinating humans. How could such methods be effective when the source of the infection is not dealt with?” he said.

Grave Concerns

It’s unclear how the erroneous belief that rabies can lurk in humans undetected for decades first spread, but it has proved as virulent as the disease itself, even infecting reporters, officials and doctors. It has led some to suffer an intractable fear of rabies that has in some cases sparked mental illness. In his article, Yan claimed China was home to hundreds of thousands of sufferers of an irrational fear of rabies bordering on psychosis. He says this fear has led to anxiety and depression and in some cases even suicide.

Yan’s blog post provoked a frenzied response from many who appeared to suffer from this delusion, responding with comments like: “Are you sure that rabies will not lurk in my body?” and “Are you sure that the vaccines have eliminated every cell of the virus from every corner of my body?” Despite Yan’s assurances and detailed explanations, many remain skeptical. Yan said he was aware of a patient who had vaccinated himself 150 times since suffering a dog bite 10 years ago, and others that quit work after getting bitten, resolute in the belief they would die from rabies regardless of their vaccination status.

The recent Changsheng scandal cast such a shadow over the public that many who had been bitten by a dog before, or even by a bird or a chicken, flooded the internet to find out whether they may still have the virus.

“I’ve read Yan’s articles and know about the WHO’s ‘10-day observation period,’ but still couldn’t help worrying. I kept asking my neighbor about his dog [that bit me] for 10 days, and even though I know it’s healthy, I’ve had a whole set of vaccines anyway,” Liu Xiaoyun (pseudonym), a Beijing woman, told NewsChina. “It’s a good thing I didn’t have any Changsheng vaccines, or I wouldn’t have been able to sleep... I don’t know why I fear it so much,” she added.

“I’m well aware that I’ve been struck by a [psychological] fear of rabies. I think all kinds of things are related to rabies. Just now, I saw there was a spot on the cigarette I was smoking and I couldn’t help but wonder if it was infected by rabies...” an anonymous netizen posted on a medical consultation forum.

For years, doctors and experts like Yan have continued to fight against these misconceptions, but with little success. It seems they have no way of convincing people who believe in old Chinese media reports and rumors about people dying of rabies 10 years after being bitten, or while the dog in question was still alive. Although experts have reiterated that such rumors were unfounded and the WHO had no records of such cases, opponents still argue that nobody can afford to gamble with their lives.

It is no wonder, Yan said, that Chinese people consume 70 percent of the world’s human-use rabies vaccines, a figure so high that some insiders attribute it to vaccine producers and sellers purposefully stirring up fears in order to increase profits.

“Rabies vaccines for human consumption are misused in many non-infected regions. For example, some places in western and northeastern China where there are nearly zero recorded cases, still consume 10,000 or 100,000 doses of the vaccine each year,” Yan wrote in his article for NewsChina.

Lack of Control

While misuse continues, Yan said rabies still goes unchecked in high-risk regions – mostly rural areas where people are ignorant of the disease and its prevention. “Among all consumers of vaccines in China, only 12 percent were actually exposed to the virus. In other words, 88 percent of people who should have taken vaccines did not do so, and those who rushed to vaccinate themselves out of fear are doing so unnecessarily,” Yan contended.

Data from the Chinese Center for Disease Control and Prevention (CDC) showed that China’s number of human rabies cases bottomed out at the end of the 20th century following an increase in the 1980s. But the figure rose again in the early 21st century. In 2007, China reported 3,300 cases, about 20 times that of 1996. Although the figure has dropped annually, it has not yet returned to the lowest point in the 20th century.

An increase in the number of dogs is believed to be a major cause. China’s fast economic growth has enabled many families to keep dogs as pets, but they may lack awareness about the need to vaccinate against rabies.

“Vaccinate dogs? Are you kidding me? We’re doing as much as we can just to vaccinate humans,” Yang Xiuli, a woman in a Shanxi Province village, told NewsChina. Yang said few rural people believe it necessary to vaccinate dogs. There isn’t even a place to get animals vaccinated in her village. She said most villagers feel that humans should be prioritized over dogs – and vaccinations are no exception.

Yang’s words were echoed by Gao Bin, an elderly man in a suburban village of Beijing where families are rich enough to afford cars but few vaccinate their dogs. “Aren’t vaccinations for city pets only? I’ve never heard of a country dog getting vaccinated,” he told NewsChina.

While urban areas see higher vaccination rates, as more dogs are abandoned and roam the streets, the threat of rabies increases. Media reported that China is home to around 200 million dogs. At least 40 million are strays. However, according to Yan, only 40 percent of all dogs in China are vaccinated, and that percentage is likely to be even lower among strays. In a 2017 report, Chengdu Economic Daily revealed that only 10 percent of all strays in Chengdu were vaccinated.

Even dog-related NGOs and animal protection groups are failing on this issue. Wu Li, a young woman who volunteers with a dog protection NGO in Chongqing, told NewsChina that many small animal protection organizations do not vaccinate stray dogs. “Cost might be a factor… but I think the main reason is the fact that they’re not aware that strays should be examined and vaccinated against rabies as soon as they are rescued from the streets,” she said.

According to Wu, it generally costs 10 yuan (US$1.3) to vaccinate a dog with domestically made animal vaccines – much cheaper than vaccinating a human. However, few people, especially those in rural areas, see it as the dog owner’s responsibility to vaccinate their pets.

Perhaps that’s why fear of rabies remains rampant: Despite experts explaining vaccinated dogs cannot transmit rabies, public fears persist in part because no one ever knows for sure whether a dog has been vaccinated or is healthy.

“The WHO’s 10-day observation period is of great help in easing people’s fear of rabies. But it should be noted that many people are bitten by strays. In such cases, the observation period becomes difficult because they have no way to locate the stray that bit them nor the expertise to observe them,” Yin Wenwu, a chief physician at the CDC, said during a video interview with news portal sohu.com.

According to the WHO, the only effective way to eliminate rabies is to vaccinate at least 70 percent of all dogs. Yet, China’s most common way of controlling rabies remains clubbing strays to death on the streets. This not only does little to reduce rabies, but also triggers fierce conflict between dog owners and the general public.

Some big cities, including Beijing and Shanghai, have pet registration systems and require that owners vaccinate their dogs. Such regulations, however, were poorly implemented, partly because of a lack of public awareness campaigns. NewsChina found it difficult to find any dog owners in Beijing that knew of free vaccination services for registered dogs. One interviewee said that the epidemic prevention station near his village is rarely visited.

Strays are in a worse state. Since China has no special system for animal control, Wu says whether or not strays get vaccinated comes down to the financial situation and awareness of their adopters.

“As far as I know, NGOs in Chongqing generally have to pay to examine and vaccinate the dogs they’ve adopted. No government department provides any support or assistance,” Wu told NewsChina.

For some years, Yan has been pushing for a mass compulsory vaccination drive by the government. “Latin American countries launched nationwide campaigns of compulsory dog vaccinations in the 1980s that were really effective. By 2010, those countries had all but eliminated the disease,” he said. “If we shift our control focus from humans to dogs, we can eliminate rabies within three to five years.”

Yan believes most people may be reluctant to vaccinate dogs because domestically made vaccines were once not as safe as imported, pricier ones. Since 2010, Chinese enterprises have been capable of producing dog vaccines that match the quality of imports for much cheaper, only to face sluggish sales. Yan believes a large uptake from the government could help companies increase sales and popularize vaccination for dogs at the same time.

His idea was supported by various experts and added to the personal agendas of several delegates at the National People’s Congress in 2017. Besides compulsory vaccination, some delegates also suggested national legislation for management of strays and pet dogs.

These suggestions and proposals conform to China’s 2011 pledge to eliminate rabies by 2025. China is expected to shift the focus to dogs. Given the WHO proposed eliminating rabies from the globe by 2030 back in 2015, Yan believes this is a crucial time for the Chinese government to implement mass compulsory vaccinations.

Wu Li, however, is less optimistic. “I doubt if it’ll be implemented well with strays, given their numbers and distribution. The government has not even appointed a department to manage strays,” she said. But Wu still has faith in the government’s pledge to eliminate rabies. “I think it will be easier for the government to cooperate with NGOs. They can set up a department to coordinate with NGOs, for example. If the government can provide assistance on sharing information and the costs of vaccinating strays, that would be sufficient,” she said.

A worker takes a photo of a dog after it received a rabies shot in Nanjing, Jiangsu Province

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